| Lifetime Dental, Pa | |
|
10750 Barker Cypress Rd Ste 111 Cypress TX 77433-2282 | |
| (281) 213-8666 | |
| (281) 256-2819 |
| Full Name | Lifetime Dental, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10750 Barker Cypress Rd Ste 111, Cypress, Texas |
| Authorized Official Name and Position | Samaneh Maryam Daftarian (DENTIST/ PRESIDENT) |
| Authorized Official Contact | 2812138666 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Dental, Pa 10750 Barker Cypress Rd Ste 111 Cypress TX 77433-2282 Ph: (281) 213-8666 | Lifetime Dental, Pa 10750 Barker Cypress Rd Ste 111 Cypress TX 77433-2282 Ph: (281) 213-8666 |
| NPI Number | 1639340128 |
|---|---|
| Provider Enumeration Date | 03/12/2008 |
| Last Update Date | 11/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639340128 | NPI | - | NPPES |
| 178127001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Texas) | Primary |
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